| NPI | 1013044619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 4437) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11244) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2023-12-01 |